AAMC report urges U.S. teaching hospitals to deal with conflicts of interest in clinical care

A new report by the AAMC (Association of American Medical Colleges) urges U.S. teaching hospitals to establish policies that manage financial relationships between physicians and industry so that they do not influence patient care. "In the Interest of Patients: Recommendations for Physician Financial Relationships and Clinical Decision Making" provides guidance on how academic medical centers can identify, evaluate, and disclose conflicts of interest in clinical care.

The report is the work of a task force convened by the AAMC in 2009. The 20-member panel, comprising senior leadership from the nation's medical schools and teaching hospitals, was chaired by Patrick J. Brennan, M.D., chief medical officer and senior vice president at the University of Pennsylvania Health System. In the report, the task force points out that partnerships between academic medical centers and industry are essential to innovation and create powerful collaborations that benefit all patients. However, the presence of individual or institutional financial interests in these relationships sometimes creates perceived or real conflicts of interests in patient care.

"Because patients and the health of the public are top priorities for the nation's medical schools and teaching hospitals, we must uphold the highest standards of professionalism, while maintaining principled relationships with industry to improve patient care," said AAMC Chief Health Care Officer Joanne M. Conroy, M.D. "The AAMC believes this report reflects these values by recommending institutions develop systems to address conflicts of interest in ways that protect patients overall and preserve the integrity of individual relationships between physicians and their patients."

Although many academic medical centers have conflicts of interest (COI) policies that govern research and corporate relationships, only a small number of these institutions have adopted policies that define and address conflicts of interest in clinical care. To help academic medical centers develop guidelines, the report suggests that institutions first evaluate their own compensation systems to determine whether they influence physician behavior and conflict with the best interest of patients. The report also recommends that academic medical centers:

- Establish mechanisms to identify physician-industry financial relationships and evaluate their potential to bias the clinical decision-making of physicians

- Consider payments for services, royalties, and ownership when assessing individual related financial interests

- Set thresholds for physician reporting and institutions' evaluation of reported interests

- Make available to their patient communities and the public information on the industry relationships of their physicians, their value, and efforts to mitigate any bias resulting from these relationships.

The report also urges teaching hospitals to involve patients in helping them to determine what information about physician-industry ties is useful to them and how it should be presented to specific patient groups.

"Many of the concerns regarding conflicts of interest in clinical care are not unique to the academic medicine community, and can be applied across the practice of medicine," said Patrick J. Brennan, M.D., chair of the task force. "We believe these recommendations will provide guidance for how to implement policies that will meet the needs of both patients and the institutions that care for them, while more research is conducted on this issue."

As a follow up to the report, the AAMC is now developing clinical scenarios that can be used by its members to help define their approach to addressing conflicts of interest in patient care.

"In the Interest of Patients: Recommendations for Physician Financial Relationships and Clinical Decision Making," is the third and final report by the AAMC on managing financial conflicts of interest. The first two association reports focused on conflicts of interest in the research and medical education settings.

SOURCE Association of American Medical Colleges